Binge eating disorder (BED) is the most common eating disorder and is associated with obesity, metabolic comorbidities, and psychiatric burden. While psychotherapy remains the first-line treatment, pharmacologic options are increasingly explored. Topiramate, an antiepileptic drug with appetite-suppressing and satiety-enhancing properties, has been investigated in randomized controlled trials (RCTs) for BED.ObjectivesThis meta-analysis aimed to determine the efficacy of topiramate in BED. Specifically, we evaluated its effects on binge frequency and weight outcomes.MethodsWe systematically searched PubMed, Cochrane, and ClinicalTrials.gov through September 2025 for RCTs evaluating topiramate in BED. Eligible trials compared topiramate with placebo in adults with BED or bulimia nervosa. Data on binge frequency, abstinence rates, and weight change were extracted. Risk of bias was assessed with Cochrane criteria. Random-effects models were used to pool outcomes.ResultsFour RCTs with 550 participants were included. Topiramate significantly reduced binge eating frequency compared to placebo, with a pooled mean difference of 1.35 (95% CI: 0.71–1.99; p =